• More injuries occur with running than swimming or cycling, and this can be due to the increased forces in the body of over 4-5 times skeletal shock to the joints as opposed to walking.
• Injuries can occur from acute injuries, cumulative small tears such as microtrauma, or reduced oxygen to cells which is called hypoxia.
  

THE CUMULATIVE INJURY CYCLE:
The cumulative injury cycle can occur with repetitive effort. With fatigue, increased pressure, tension or friction can occur in the tissues. The body will lay down tough scar tissue to repair the area. This is the body’s attempt to stabilize an overworked area. This can result in fibrous adhesions in muscles or soft tissues in the body. As a result, muscles become shorter and weaker, and may not able to transmit effective power or “give” like we ask them to function in our athletic activities.
Trapped nerves may not transmit signals and prolonged friction, pressure or tension can result in inflammation. This can over time reduce range of motion in structures, and lead to a loss of strength in the area. Tingling, numbness and weakness can also occur and increased pain signals are a result of this cycle.

What are the most common causes of injuries?
1. Overtraining
2. Not allowing for proper recovery
3. Muscular imbalances
4. Biomechanical faults. Asymmetrical movement, along the kinetic chain which can include improper flexibility at the foot, hip, knee, ankle, spine and all the way up to the neck and shoulder.
5. Joint restrictions
6. Muscle restrictions
7. Poor core strength and/or flexibility
8. Poor balance, neuromuscular control and proprioception

Fourteen Tips to Prevent Injury:

1. Listen to your body:
Allow for recovery, particularly if one feels irritable, possesses low motivation, or has an inability to get the heart rate up in the workout and a feeling of tiredness, moodiness, disruptive sleep patterns.
Test the morning heart rate; if it is 10 beats higher, there is a good chance that your body is in need of serious recovery. It is good to take some needed rest.

2. Avoid overtraining. Studies show that the best injury predictor may be the amount of training you completed last month. It is well known that fatigued muscles cannot protect associated connective tissue structures, and this increases the risk of damage to bone, cartilage, tendon and ligament. Total mileage for running is an excellent indicator of your injury risk. A good rule of thumb is not to increase your mileage over 10% a week. Recovery time reduces injury rate by giving muscles and connective tissues an opportunity to repair.

3. Get regular massage, particularly during your buildup phase, and during recovery. No longer are massages just to “feel good”. I find that massage helps tremendously to release muscle restrictions, improve blood flow, remove lactic acid, relax the nervous system, and improve one’s recovery after training. It is essential to incorporate into an athletes’ program and should be a part of ones’ body maintenance schedule.

4. Strengthen weakened muscles. Many athletes who have been sedentary and start to exercise more vigorously may have problems that pop up due to some underlying weakness or muscular imbalances. It is extremely wise to couple resistive training with swimming, biking and running. Increasing training should correspond with an increased effort for stretching and strengthening.

5. Allow plenty of time for proper warm-up and cooling off and stretching after your workout, while the muscles are still warm.

6. Replacing shoes after 400-500 miles and using adequate shoes for your type of arch. For example, a hyperpronator needs a more stable heel counter or a motion control shoe, whereas someone with a high arch may tend to supinate more and may not need an extremely rigid shoe. It’s good to try many shoes in order to get a good fit and run in them in the running store before you buy them.

7. Treat even minor injuries with the RICE principle: rest, ice, compression and elevation. Do not train when experiencing pain, which can lead to further injuries and other compensations. It’s important not to train hard when you are stiff or have muscle soreness from the previous effort. The next effort should be easy.

8. Muscular imbalances can result in the repetitive motions of swimming, cycling and running and the poor postures associated with being in the bike position. Motion in these sports occurs primarily in the sagittal plane (forward motion). As a result, many athletes may develop tightness of their rotatore muscles and those that allow side-bending and rotation of the spine. Another underlying cause of injuries is inadequate motion in the hips and pelvis. Exercises that improve rotation and sidebending are important exercises for the triathlete ...”use it or lose it”!

9. Strength of the core is essential for transmitting forces in the body. The core of the body is where you derive power. It provides the foundation for all arm and leg movements. Body movement is a complex event with agonist-antagonist structures working together in synergy to provide strength, stability and motion while at the same time the body is also able to stabilize in all three directional planes of motion. This is essential for optimal performance, symmetry and fluidity in the athlete. Core muscles are comprised of the multifidus, the interspinalis, intertransversii, rotatores, abdominals, transverse abdominus, internal/external obliques, erector spinae, and quadratus lumborum thoracolumbar fascia. It’s important to remember that the body has a kinetic chain with relation to all its parts and these relationships affect one another. It is therefore common to see an athlete who complains of foot pain that may actually have a problem with spinal rotation or hip weakness that is contributing to an overuse of the foot structures. This is just one example.

10. Exercises can go a long way in preventing these imbalances from resulting in an injury. It is important to perform a daily stretching program and incorporate strength, training and core stability exercises into a triathlete’s training program.
In summary, stretching maintains flexibility and will avoid the cumulative muscle shortening that can occur with repetitive activity.

11. What to do if a musculoskeletal injury occurs:
Rest, stop further activity and apply ice. It is known that ice can reduce inflammation and swelling, speeding healing time, and also this would be used particularly after a hard workout if soreness shows up. Elevation and compression can help with swelling. Seek care if the pain persists more than a few days.
Triathlon fitness and good running takes months and years to develop. Emphasizing consistency and patience is key. If you are new to this sport, build up gradually and learn proper techniques in all disciplines.
If you are having pain: See a physical therapist or medical provider who works with triathletes. Get a biomechanical analysis. If you are having any residual pain during or after a workout, seek medical care with a practitioner that understands these types of injury from a prevention standpoint. A full evaluation of your problem can avoid further injury and return more quickly to activity. I have found that Active Release Techniques® to be an effective treatment for most musculoskeletal injuries coupled with appropriate and specific rehab exercises and can return the athlete quicker to full activity and improve performance by improving the body’s efficiency.

12. Cycling: Bike fit is crucial to optimum function and to avoid injury. I suggest a proper bike fit with a professional who understands triathletes’ needs.

13. Running: Follow the 10% rule. Increase weekly mileage no more than 10%, and after 3 weeks there should be a decrease in one’s mileage to allow for proper recovery. We’ve already talked about maintaining proper running shoes and replacing when worn. Try to run on soft terrain or trails to decrease skeletal shock and pounding stress to the joints.

14. Last but not least, have fun! Enjoy a balanced perspective on training.

1. “Foot caves in” (dropped navicular or arch)
Weakness of posterior tibialis, foot intrinsics, anterior tibialis, tight gastrocnemius or soleus

2. Poor knee control, knee “caves in”:
Poor stability of gluteus medius in the hip, poor quadriceps control

3. Anterior pelvic alignment
Limited hip extension usually a tight psoas; poor core stability

4. “Forward flexed trunk”
Tight psoas, rectus femoris, abdominal shortening (rectus)

5. Asymmetrical arm swing
Many causes, can include poor trunk rotation; tightness of transverso-spinalis, multifidi; core or scapular weakness; upper trapezius tightness

6. Asymmetrical shift or transfer of weight
Lumbopelvic/ hip weakness or stability and/or muscular tightness

7. Shortened stride and posterior tilt of the pelvis: shortened hamstrings
A biomechanical assessment that includes functional joint/muscle testing can help evaluate your weak links. We, at SOLPT, offer digital video analysis to identify and design a customized rehab or performance program to optimize your running efficiency.